Keywords: Appendicitis, Pediatrics (PubMed Search)
Acute Appendicitis in Childhood: Diagnosis and Treatment in the new Millennium. PEM Practice. December 2008
Keywords: metoclopramide, black box warning, tardive dyskinesia (PubMed Search)
Add metoclopramide (Reglan) to the laundry list of medications with black box warnings from the FDA. Why was a black box warning added?
Keywords: nihss, stroke scale (PubMed Search)
Keywords: Hypertensive (PubMed Search)
Follow-up for the Hypertensive Patient
We see hypertensive patients every day, every shift. And, we discharge many of them. So, when do you get them follow-up?
The JNC-7 recommends that patients with BPs > 180/110 mm Hg have follow-up within 7 days. Like most of the HTN recommendations in the primary care setting, this recommendation is based on a "smart person" concensus....and no data.
This is a tremendous issue for us in the ED, because we don't want to see a bad outcome in our discharged hypertensive patients.
Some pearls regarding discharging the very hypertensive (but asymtomatic) patient:
Keywords: tamponade, pericardial tamponade, intubation, positive pressure ventilation, complications (PubMed Search)
Keywords: Galeazzi, Fracture (PubMed Search)
The Galeazzi Fracture:
To see a photo of a Galeazzi fracture please visit the Learning Radiology Website by clicking on the following link:
Rocky Mountain spotted fever (RMSF)
Systemic small vessel vasculitis caused by R rickettsii which is transmitted by a tick bite.
Clinical features: fever, headache, myalgia, nausea, vomiting, and characteristic rash. Rash usually appears before the sixth day of the illness initially on the wrists and ankles, and spreads to the trunk within hours. Initially. It is erythematous and macular, later becoming petechial.
Laboratory findings: thrombocytopenia, anemia, and hyponatremia.
Complications: meningitis, multiorgan involvement, DIC, shock, and death.
Treatment: doxcycycline (even despite the risk of dental staining in children younger than 8 years old)
Keywords: Clevidipine, calcium channel antagonist, calcium channel blocker, antihypertensive (PubMed Search)
1. Anon. The Medical Letter. Sept 22 2008;50(1295)73-4.
Keywords: cavernous sinus thrombosis, extraocular palsies (PubMed Search)
Keywords: Hypertension, End-Organ Damage (PubMed Search)
Evaluation of End Organ Damage in Hypertensive Patients
No evidence to date supports the ED workup for end-organ damage in asymptomatic hypertensive patients.
End-Organ Damage Pearls:
Category: Critical Care
Neuromuscular Blocking Agent (NMBA)
Keywords: electrocardiography, acute myocardial infarction (PubMed Search)
Keywords: Ottawa, Ankle, Knee, Foot (PubMed Search)
Most people are familiar with the Ottawa Ankle Rules, but there are also Ottawa Knee and Foot rules. The Ottawa rules help to limit the number of x-rays you may need in patients that present with ankle, foot or knee pain after an injury.
The Ottawa Ankle Rule
An ankle x-ray is only needed if there pain in the mallelolar area and any of the following:
The Ottawa Foot Rule
A foot x-ray is only needed if there is pain in the midfoot and any of the following:
The Ottawa Knee Rule
A knee x-ray is only needed for knee injury patients when they have any of the following:
Keywords: pediatric seizures (PubMed Search)
Berg C, Schumann H. An Evidence-Based Approach to Pediatric Seizures in the Emergency Department. Pediatric Emergency Medicine Practice. Feb 2009. Vol 6, Number 2.
Keywords: ondansetron, albuterol (PubMed Search)
Category: Critical Care
The Crashing Intubated ED Patient
Category: Airway Management
Keywords: Brugada syndrome (PubMed Search)
Keywords: AV fistulas, bleeding (PubMed Search)
Bleeding AV Fistulas
It is not an uncommon complaint for dialysis patients to present with bleeding from their fistula. They can lose a large amount of blood in a short period of time if not treated promptly, and if treated too agressive their fistula can clot off. Some tips on how to control the bleeding.
Most of the bleeding occurs at the site that the needle puntured the fistula. If it is due to an ulcer eroding into the fistula these tips may not be effective.
I typically check a CBC and coags. Once the bleeding is controlled observe the patient for awhile [typically the hour to hour and half to get the labs back] and then road test them with a walk around the Emergency Department to ensure it does not start bleeding again.
Krogstad P. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders Co; 2004713-736.
Tan TQ. Osteomyelitis and septic arthritis. In: Perkin RM, Swift JD, Newton DA, eds. Pediatric Hospital Medicine: Textbook of Inpatient Management. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:497-500.
Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R. Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months. Arch Pediatr Adolesc Med. 1995; 149:537-540.
Keywords: rocuronium, succinylcholine (PubMed Search)
Rocuronium is fast becoming the agent of choice for RSI in the Emergency Department. Here is a head to head comparison of the two drugs to understand why:
Severe Brady rare
Other Adverse Effect
No fasciculations, No ICP effect, No Rhabdo
Fasciculations, increase ICP, rhabdo, movement of displaced Fxs